Deck 16: The Health Care System: Financing, Issues, and Trends

Question 1

Diagnosis-related groups (DRGs) and prospective payment systems are most clearly the reason for

A) Medicare and Medicaid.
B) critical pathways and managed care.
C) group health insurance and centralization.
D) a shortage of nurses and unlicensed assistive personnel.

Answer 1

critical pathways and managed care.

Question 2

Which of the following is a quality improvement activity in which the LPN/LVN engages routinely?

A) Collecting data for care plan development
B) Identifying nursing diagnoses
C) Initiating patient teaching about medications
D) Evaluating patient goal attainment

Answer 2

Collecting data for care plan development

Question 3

When the nurse is asked by a patient, "Why is it necessary to have deductibles and copayments when I already have health insurance?" The best response would be:

A) "They are a way to improve the margin of profit in the fee-for-service method of paying for health care."
B) "They prevent health care agencies from having huge deficits associated with uncompensated care."
C) "They were developed to save health care dollars at the time Medicare introduced DRGs."
D) "They are part of the incremental changes designed to provide more universal care."

Answer 3

"They are a way to improve the margin of profit in the fee-for-service method of paying for health care."

Question 4

A 70-year-old patient tells the nurse, "I can't go to the hospital for treatment because I have no hospital insurance. My Social Security and my pension pay my living expenses, but I don't have any savings." The nurse's response should be focused on

A) providing information about Medicare.
B) explaining the provisions of Medicaid.
C) exploring the patient's ability to purchase group health insurance.
D) investigating which hospitals provide free care for indigent patients.

Question 5

A trend in health care that may negatively affect the number of practical nurses hired by an agency is

A) the aging of the U.S. population.
B) the increased use of unlicensed assistive personnel.
C) decentralization of health care agencies.
D) the emphasis on critical thinking and problem solving.

Question 6

The yearly amount an insured person must spend out-of-pocket for health care services before a health insurance policy will begin to pay its share is known as the

A) premium.
B) deductible.
C) copayment.
D) coinsurance.

Question 7

When involved with discharge planning for a patient recovering from a mild cerebrovascular accident, the nurse should understand that Medicare provides

A) longer stays for Medicare patients in acute inpatient settings.
B) increased use of extended care units for rehabilitation needs.
C) inappropriate early discharge of large numbers of patients.
D) universal coverage for U.S. citizens and permanent residents.

Question 8

A set monthly fee charged by the provider of health care services for each member of the insurance group for a specific set of services is known as

A) inflation.
B) capitation.
C) fee-for-service.
D) gross domestic product.

Question 9

Which program offers an incentive to hospitals to discharge patients as quickly as possible?

A) Retrospective payment system
B) Prospective payment system
C) Seamless system
D) Private insurance plans in effect for under 1 year

Question 10

A student nurse asked to identify the types of services currently provided in the U.S. health care delivery system should mention which of the following? (Select all that apply.)

A) Restructuring
B) Health promotion
C) Diagnosis and treatment
D) Illness prevention
E) Seamless systems
F) Alliances and networks

Question 11

A mother and her three children often seek medical services at the emergency room. The nurse realizes that they have no insurance and are unable to pay for services. The action the nurse should take that would provide the greatest assistance to the family would be to

A) advise them to use urgent care centers where fees are lower.
B) leave the newspaper classified ads in a visible place.
C) advise the mother to seek work at the hospital personnel office.
D) contact a social worker to discuss Medicaid with the mother.

Question 12

The skill that will be most helpful to an LPN/LVN in navigating health care system changes successfully is

A) the ability to work efficiently for long hours.
B) problem-solving and critical thinking abilities.
C) identifying the need for comprehensive system change.
D) becoming knowledgeable about CQI processes.

Question 13

A patient tells the nurse, "I didn't sign up for health care insurance at my job because I'm young and healthy and can use the money in other ways." The response that best explains the advantage of health insurance would be

A) "With insurance a fiscal middleman pays your health care bills."
B) "With insurance your individual contributions go directly to paying your personal expenses."
C) "With insurance you can borrow money for unexpected health care expenses at a very low interest rate."
D) "With insurance you are spreading the risk in case you have a serious health event, such as cancer or major trauma."

Question 14

A method of financing health care costs in which physicians are paid a fee by the patient for each service they provide is known as

A) inflation.
B) capitation.
C) fee-for-service.
D) gross domestic product.

Question 15

Which LPN/LVN will be most successful in dealing with change?

A) Nurse S, who always assumes that the worst will happen in any situation
B) Nurse T, who agrees with whatever the administration proposes
C) Nurse U, who sees change as an opportunity to improve conditions
D) Nurse V, who predicts that the change will probably not work

Question 16

A patient tells the nurse, "I received a questionnaire that said my answers would be used for purposes of continuous quality improvement. I wonder if it's worth my time to fill it out?" The response that best explains continuous quality improvement is:

A) "Continuous quality improvement activities are used to restructure hospital departments and personnel assignments to ensure cost savings."
B) "Continuous quality improvement activities are used to provide an opportunity for staff members to participate in self-governance."
C) "Continuous quality improvement activities are used to obtain appropriate reimbursement for care given to ambulatory and inpatients."
D) "Continuous quality improvement activities are used to monitor and improve processes involved in providing safe, effective care for patients."

Question 17

Which of the following constitutes a problem that affects data collected by the nurse interviewing a chronically ill older adult patient? Many older adults who are covered only by Medicare Parts A and B find it difficult to pay the cost of

A) hospital care for an acute short-term illness.
B) prescription drugs while living at home.
C) post-hospitalization rehabilitation services in a skilled nursing facility.
D) doctor's office visits, Pap smears, and mammography.

Question 18

A patient asks the nurse, "What do health maintenance organizations (HMOs) do to reduce health care costs?" The response giving the best example of an HMO cost-containment method would be:

A) "HMOs pool individual contributions for use in catastrophic illness."
B) "HMOs provide supplemental coverage for items not covered by Medicare."
C) "HMOs use a retrospective payment system."
D) "HMOs provide services aimed at keeping members healthy."

Question 19

The monthly fee a person must pay for health care insurance coverage is known as the

A) premium.
B) deductible.
C) copayment.
D) coinsurance.

Question 20

Which of the following phrases could be used by a nurse to characterize the present health care delivery system in the United States? (Select all that apply.)

A) Responds to illness
B) Is oriented to promote wellness
C) Provides for universal access
D) Depends on national health insurance
E) Is fragmented and confusing
F) Is unsafe

Question 21

The amount an insured person must pay at the time of an office visit, when picking up a prescription, or before a hospital service is known as the ______________________.

Question 22

The LPN/LVN charge nurse has been designated to participate in the orientation of a new LPN/LVN by explaining cost-containment measures. Measures the charge nurse should mention include which of the following? (Select all that apply.)

A) Charge patients for all supplies used in their care.
B) Document patient care according to the policy for reimbursement.
C) Use time management principles to work efficiently.
D) Use supplies carefully to avoid waste.
E) Implement measures to prevent complications.
F) Advise insured patients to select higher tiers whenever possible.

Question 23

Once a deductible has been met, the percentage of the total bill paid by the insured person is known as the _________________.

Question 24

Which of the following are problems associated with the present health care delivery system that could be identified by a nursing student who is writing an essay? (Select all that apply.)

A) High cost
B) Insufficient number of doctors
C) Widespread shortage of RNs
D) Continuous quality improvement